John Q. Cook, M.D.

Facial Fat Transfer Restores the Fullness of Youth

Dr. John Q. Cook and the team at the Whole Beauty® Institute are leaders in the field of facial volume enhancement. Our approach to facial volume derives from Dr. Cook’s two decades of experience with facial fat transfer.

Almost 20 years ago Dr. Cook saw the potential of fat transfer to restore the volume loss that often accompanies facial aging. People often begin to lose their natural facial fat their late thirties, and the process accelerates with each passing decade. The upper cheeks, the temples, the lips, the chin, and other facial areas begin to look gaunt and hollow. Dr. Cook was one of the first plastic surgeons in the Midwest to carry out facial fat transfer in order to restore facial volume, both as an independent procedure and as part of facial rejuvenation surgery. He has carried out fat transfer in several thousand patients.

In recent years a variety of injectable fillers are available for restoring facial volume at a variety of levels. The workhorse for deep volume restoration is Voluma®, while thinner fillers, such as Restylane® and Juvederm® can be used closer to the surface of the skin. Our patients benefit from the fact that Dr. Cook has applied the principles of fat transfer to volume restoration with injectable fillers. The entire team at the Whole Beauty® Institute follows the approach that Dr. Cook uses when he carries out fat transfer. This includes the frequent use of blunt cannulas, a multi-layered restoration of volume, and a deep understanding of the anatomy of the area.

Although the majority of volume enhancement procedures are carried out to correct the loss of facial fullness that occurs with aging, there are also situations where a patient is lacking in facial volume due to an underdevelopment of the facial bones, particularly in the cheeks or chin. In this case fat or fillers can be used to build up the soft tissues overlying the areas of weak bone structure. Another possibility is the use of cheek and chin implants, which are placed directly on the areas where the bone structure is lacking.

Autologous Fat Transfer: A Missing Link in Facial Rejuvenation

A Featured Medical Report: American Health Front

Dr. John Q. Cook Describes his Approach to Facial Fat Transfer

Autologous Fat transfer is one of the most popular procedures in my practice. I obtain living fat cells from a region of excess, such as the abdomen, and transfer the cells to a region that needs filling out, such as the cheek or lip. These are zones that lose their youthful fullness as an individual ages. When I began working with fat transfer almost 20 years ago, the procedure was not well-known in the Midwest. I am happy to see more surgeons using the wonderful technique in the last few years.

The techniques that I have developed for fat transfer allow me to address one of the fundamental aspects of facial aging, a loss of fullness in the cheeks, lips, and other key areas that help to create an attractive, youthful face. As we age and the natural fat cells begin to disappear, the soft, full curves of these zones become hollow and fragmented. Think for a moment of the way the cheek and lower eyelid blend imperceptibly in a healthy 18 year old. The cheek is certainly not hollow – it has a wonderful firmness and fullness. When we look at such a cheek we think of health and vitality.

Unfortunately as we age, the upper cheek fat thins out. The lower eyelid appears to bulge because the fat that so beautifully camouflaged it is gone. If surgeons address this critical expressive area by mindlessly removing fat from the lower eyelids, they will only make the area more hollow and fragmented. This is the standard approach to eyelid rejuvenation – an aggressive destruction of the fat that supports the eye and an attempt to pull the skin tight that often reduces the eye’s expressive quality. I am not suggesting that there is never a place for diminishing the fullness of fat in heavy lower eyelids. There are patients who can benefit from a judicious resculpting, or repositioning of this fat. However, for most patients the key issue is to restore fullness to the overlying cheek. Remember that the fat of the lower eyelids has always been there – it just loses its camouflage as we age and the overlying fat of the upper cheek thins out.

Fat transfer is a critical component of my facelift technique, but it can also be carried out as an independent procedure. It is particularly useful for patients who are not yet ready for a facelift, but who have noticed signs of aging in the upper cheek or around the mouth and in the lips. Some patients prefer to undergo fat transfer under a light anesthesia, so that they have no recollection of the procedure, while others select local anesthesia. We can help you determine the approach that is appropriate for you during a consultation at one of our Chicago centers.

With fat transfer the results are highly dependent upon the surgeon’s technique and artistic judgment. I feel that the visual concepts that I have derived from careful study of Renaissance painting as well as years of study of the facial aging process, allows me to form an image that guides me in the creation of form for each patient.

Fat transfer is truly a transplant operation, in which living tissue is moved from one area of the body to another. The fundamental issue is the same as that of a heart or kidney transplant – survival of the transplanted tissue in its new location.

To obtain survival of the greatest percentage of transferred fat cells, two key rules must be followed. First, the fat cells must be obtained, or harvested with an extremely gentle technique. Standard liposuction equipment cannot be used to harvest fat cells, since it subjects them to excessive pressure and causes disruption of the delicate cell membrane. The second rule is that cells must be transferred gently, precisely and in tiny channels. This provides the cells with the best chance of obtaining a blood supply, without which they will not survive.

The recovery from fat transfer is easy for most patients. Our patients tell us that they are pleasantly surprised by how little pain there is after surgery. There will be considerable swelling and bruising in the zones of fat transfer, so that most patients will prefer to take at least a week off from social interaction or work that involves client contact. We provide each patient with specific guidelines based on the extent of surgery and the person’s individual needs.

I’ve performed several thousand of fat transfer procedures, and I am able to obtain 30 – 40% survival of the transferred fat cells for the significant majority of patients. Once the cells are in place with a good blood supply, prospects for their long term survival are excellent. As with the fat cells that are original to the region, there will be some thinning out with the passage of time – fat atrophy – after all – is a key component of the facial aging process.

Several different strategies exist for facial fat volume replacement. Many patients accept an over correction in order to obtain the maximum long term benefit from a single procedure. Others prefer a sequence of small volume fat transfers, so that they can return to work more quickly. Still others will return for additional fat transfer 1-2 years after the first procedure in order to enhance the power of the correction. As with all of our procedures, we provide each patient with highly individualized attention, so that we can design a treatment plan that is best for his or her needs.

If you would like more information about fat transfer and what it can do for you, please talk to one of my clinical team members. They will be happy to discuss the surgery and recovery process. They can also show you examples of patients who have benefited from this procedure, so that you can determine whether the results are in line with your personal vision. If this is the case, I will perform an in-depth evaluation that will lead to an individualized treatment plan.

Fat Transfer

As described above, fat transfer involves the removal of fat cells from one area of your body and injecting them into the lips. Lip augmentation with fat transfer is an increasingly popular procedure at our Chicago centers that requires no allergy testing because the substance injected into the lips is from your own body. Also, results from lip augmentation with fat transfer typically last longer than with other injectable treatments.

Sophisticated Lip Augmentation

The beautiful curves of sensuous lips are complex and any correction requires a sophisticated visual aesthetic. When lips are overdone, they do the patient a disservice. When lip enhancement is carried out with an eye to natural form, the beautiful curves and contours are brought into pleasing harmony with the rest of the face. Ou entire team at the Whole Beauty® Institute adheres to Dr. Cook’s principles of natural lip enhancement.

Lip Augmentation with Restylane®, Juvederm®, and other Fillers

Many patients come to the Whole Beauty® Institute for lip enhancement. We use fillers to emphasize the natural high points of the upper and lower lips, rather than creating lips of uniform thickness, which looks unnatural and silly. The zones around the red part of the lips can be highlighted in a sophisticated way.

We have a number of techniques that help to minimize discomfort during lip enhancement.

Chin Implants

If you have a recessed chin, a prominent nose, or would just like your chin to have more definition, chin implants from Dr. Cook can make a world of difference. Chin implants not only provide a more contoured chin, they help the entire aesthetic of the face by bringing facial features into better balance and harmony. The procedure begins with a small incision placed discreetly on the inside of the mouth or the underside of the chin. Any scarring from the incisions will not be visible to others. Dr. Cook will place the implant, made of a silicone elastomer material, directly in front of the jawbone and close the incision. The procedure generally takes about an hour, and recovery time is minimal. Chin implants can often be placed in tandem with a rhinoplasty procedure, which can give even greater improvement to facial proportions.

Cheek Implants

Cheek implants can add more contour and definition to your face, creating a better balance among facial features and providing aesthetic improvement to those who have weak cheek structure or whose cheek definition has been affected by the aging process. They also serve to smooth out wrinkles and generally add volume to the face. Cheek implants come in a variety of sizes, shapes and types. They are generally made of silicone elastomer, and can be easily removed. Cheek augmentation can be performed in conjunction with other aesthetic options, such as lip augmentation, chin implants, facelift, eyelid surgery, or brow lift. Otherwise, Dr. John Q. Cook will begin the cheek augmentation process by making a small incision inside the mouth. He will then fit the implant inside the cheek tissue, and close the incision. Any residual scarring is virtually invisible.

Contact our Chicago and Winnetka Centers

Dr. John Q. Cook and his leadership-level team of clinicians are highly-respected for their naturalistic approach to facial volume enhancement. We are pleased to offer our patients and extensive range of techniques that spring from Dr. Cook’s carefully developed visual aesthetic. Contact us or call 312-751-2112 to speak to one of our clinical team or to schedule a consultation in our Chicago and Winnetka offices.